INTERACTION WITH SCREENEES AND PATIENT ORGANIZATIONS

Transcription

1 ESPCG European Society for Primary Care Gastroenterology INTERACTION WITH SCREENEES AND PATIENT ORGANIZATIONS Bohumil Seifert Dpt. Of General Practice 1st Faculty of Medicine Charles University in Prague April, 26, 2013 European Colorectal Cancer Days, Brno

2 Content of the lecture Interaction with screenes - in general practice - professionals via media Interaction with patient organizations - about screening for colorectal cancer - about colorectal cancer

3 Interaction with screenes in general practice

4 Primary prevention Limited possibility. Brief interventions Systematic preventive checks Individual basis Family basis Group sessions

5 Secondary prevention Case finding/identification for hisk risk group.. GE Screening according to guidelines since age 50 - semi-opportunistic - some GPs invite. - cohort phenomenon

6 Number of FOBTs, colonoscopies and polypectomies performed Source of data: National Reference Centre National Coverage: 24,8% of target population, 30% in age group Rok Dusek, IBA, 2013

7 Adherence to screening program GP aspects - Competence (understanding, education, knowledge) - Attitudes (resistence, pasivity, activity, enthusiasm) - Management / practice organization (allocated time, appointment system,nurse involvement) - Financial motivation

8 Which method? Primary care or secondary care based programs? Colonoscopy-naive asymptomatic patients prefer FOBT over colonoscopy for CRC screening Debourcy(US) patients, age 55-64, in Italia invited for screening and randomized to 3 options: Colonoscopy, FS, FOBT - Adherence to FOBT, FS 32% - Adherence to Colonoscopy 26% Segnan 2007 Clear preference of non-invasive methods

9 View of CRC screenees The awareness exists (75%), the understanding is lower (<50%). the adherence is 25%. Personal attitudes in population vary: - some people active, prevention oriented. Education and socioeconomic status does not play a role in adherence to program.

10 Screening: practical issues Reasons for non- participation Half of non-participants decide before and half after reading kit instructions (gfobt). Procrastination (26%) Percieved unpleasantness of the test (25%) Recent bowel examination (24%) Misconception of the screening only for symptomatic (20%) Anxiety about results (8%) Worthley DL. Internal Medicine Journal 2006

11 GP: FOBT+ consultation Never expected Never welcome and always difficult - Doctor, you told me, that the test was just for sure - - I don t believe, give me another test! - I feel OK, I do not believe that something is wrong. - - I have heard about more pleasant methods than colonoscopy 10% of patients disagree with colonoscopy

12 GP: FOBT+ management 1. Make an appointment for FOBT+ patient sensitively. 2. Calm patient down in practice before giving bad news. 3. Inform what FOBT+ in screening program means. 4. Learn patient about colonoscopy (use brochures, websites, webcast). 5. Explain preparation/prescribe preparation. 6. Support an appointment for colonoscopy in specific centre, with specific physician, if possible. 7. Assess positively patient approach to his health. 8. Invite patient to come after colonoscopy.

13 Adress invitation from GP perspective System to be introduced in 2013 What will happen? How big increase in attendance (if any) we can expect? 10, 20, 30%? or more? Concern about GE capacities

14 Interaction with patients via media GP representatives are part of bodies governing screening in the Czech Republic - participate at press conferences - publish in lay magazins - present screening program in TV and radio - participate at regional promoting activities

15 Interactions with patient organizations Vize 97 Onkomajak League against Cancer ILCO

16 Facilitator of introduction of CRC screening in the Czech Republic in 2000 Council for Colorectal Cancer under the umbrella of VIZE 97 had been governing screening for years Screening promotion in media: TV spots, articles, leaflets, joint activity: Screening promotion at scientific meetings

17 Onkomajak Citizens Association - Support of cancer patients - Cancer prevention - Question and answers - Platform for discussion - Media activity COLON TOUR since 2009 Pavla Freij

18 League against Cancer Communication/interaction on: - Cancer prevention - Healthy life style - Quality of life of cancer patients - Support of research in oncology -Support of departments of Oncology

19 Key issues: ILCO Voluntary organization of stomic patients 1. support of cancer patients Bad news management: new cancer diagnosis I have a cancer, what should I do? I have a stomia, how can I live with that? 2. promotion of cancer prevention

20 ILCO Leaflets and information to surgeries (GP, onco) Network of volunteers for counselling with pts. Hospital projects: visits to patient before and after stomia surgery Cooperation with stomia nurses Books with lay case histories Cooperation with Media Participation in scientific and public meetings

21 Conclusion The role of GPs in primary care based screening programs is crucial. Continuous media education campaigne on screening is necessary Adress invitation is the next step in screening development.